In-hospital mortality and severe outcomes after hospital discharge due to COVID-19: A prospective multicenter study from Brazil

Perazzo, Hugo; Cardoso, Sandra Wagner; Ribeiro, Maria Pia Diniz; Moreira, Rodrigo; Coelho, Lara E.; Jalil, Emilia Moreira; Japiassú, André Miguel; Gouvea, Elias P.; Nunes, Estêvão Portela; Andrade, Hugo Boechat; Gouvêa, Luciano Barros; Ferreira, Marcel Treptow; Rodrigues, Pedro Mendes de Azambuja; Moreira, Ronaldo I.; Geraldo, Kim Mattos; Freitas, Lucilene; Pacheco, Vinicius V.; João, Esaú; Fuller, Trevon; Rocha, Verônica Diniz; Nunes, Ceuci de Lima Xavier; Souza, Tâmara Newman Lobato; Toscano, Ana Luiza de Castro Conde; Schwarzbold, Alexandre Vargas; Noal, Helena Carolina; Pinto, Gustavo de Araújo; Lemos, Paula Macedo de Oliveira; Santos, Carla Silva dos; Mello, Fernanda Carvalho de Queiroz; Veloso, Valdiléa G.; Grinsztejn, Beatriz

doi:10.1016/j.lana.2022.100244

“…Concerning the impact of the COVID-19 vaccination in the individuals analyzed in the present group, it is important to note that the participants included in 2020 were not vaccinated. For those recruited in 2021 (until March), we have no information on vaccination status [46]; however, the inpatients recruited in this period had WHO scores of 8-9, which eliminated any bias potentially caused by vaccination in the association between SNPs and disease protection observed in our study. Moreover, in Brazil, administration of the COVID-19 vaccine began in 2021 (end of January) exclusively for elderly people (>80 years) and health care workers, and only 2.0% of the Brazilian population was fully vaccinated on the date of censure for this analysis (March 31, 2021) [88].…”

Section: Discussionmentioning

confidence: 99%

Inflammasome Genetic Variants Are Associated with Protection to Clinical Severity of COVID-19 among Patients from Rio de Janeiro, Brazil

Sá

¹

,

Neira-Goulart

²

,

Ribeiro-Alves

³

et al. 2022

BioMed Research International

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COVID-19 has a broad spectrum of clinical manifestations, from asymptomatic or mild/moderate symptoms to severe symptoms and death. The mechanisms underlying its clinical evolution are still unclear. Upon SARS-CoV-2 infection, host factors, such as the inflammasome system, are activated by the presence of the virus inside host cells. The search for COVID-19 risk factors is of relevance for clinical management. In this study, we investigated the impact of inflammasome single-nucleotide polymorphisms (SNPs) in SARS-CoV-2-infected individuals with distinct severity profiles at clinical presentation. Patients were divided into two groups according to disease severity at clinical presentation based on the WHO Clinical Progression Scale. Group 1 included patients with mild/moderate disease ( WHO < 6 ; n = 76 ), and group 2 included patients with severe/critical COVID-19 ( WHO ≥ 6 ; n = 357 ). Inpatients with moderate to severe/critical profiles were recruited and followed-up at Hospital Center for COVID-19 Pandemic – National Institute of Infectology (INI)/FIOCRUZ, RJ, Brazil, from June 2020 to March 2021. Patients with mild disease were recruited at Oswaldo Cruz Institute (IOC)/FIOCRUZ, RJ, Brazil, in August 2020. Genotyping of 11 inflammasome SNPs was determined by real-time PCR. Protection and risk estimation were performed using unconditional logistic regression models. Significant differences in NLRP3 rs1539019 and CARD8 rs2043211 were observed between the two groups. Protection against disease severity was associated with the A/A genotype ( OR adj = 0.36 ; P = 0.032 ), allele A ( OR adj = 0.93 ; P = 0.010 ), or carrier-A ( OR adj = 0.45 ; P = 0.027 ) in the NLRP3 rs1539019 polymorphism; A/T genotype ( OR adj = 0.5 ; P = 0.045 ), allele T ( OR adj = 0.93 ; P = 0.018 ), or carrier-T ( OR adj = 0.48 ; P = 0.029 ) in the CARD8 rs2043211 polymorphism; and the A-C-G-C-C ( OR adj = 0.11 ; P = 0.018 ), A-C-G-C-G ( OR adj = 0.23 ; P = 0.003 ), C-C-G-C-C ( OR adj = 0.37 ; P = 0.021 ), and C-T-G-A-C ( OR adj = 0.04 ; P = 0.0473 ) in NLRP3 genetic haplotype variants. No significant associations were observed for the other polymorphisms. To the best of our knowledge, this is the first study demonstrating an association between CARD8 and NLRP3 inflammasome genetic variants and protection against COVID-19 severity, contributing to the discussion of the impact of inflammasomes on COVID-19 outcomes.

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“… 49 Additionally, multiple studies have demonstrated SAPS-3 and NEWS-2 scoring systems as severity and mortality predictor tools of COVID-19 infection. 50 – 52 Despite serum KL-6 having a similar AUC to this severity assessment tool, the low sensitivity of KL-6 makes it a weaker test.…”

Section: Discussionmentioning

confidence: 99%

Serum Krebs von den Lungen-6 for Predicting the Severity of COVID-19: A Systematic Review, Meta-Analysis, and Trial Sequence Analysis

Shrestha

¹

,

Pokharel

²

,

Singh

³

et al. 2023

Clin Med Insights Circ Respir Pulm Med

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OBJECTIVE This systematic review and meta-analysis aimed to find the association between serum Krebs von den Lungen-6 (KL-6) and the severity of Coronavirus disease 2019 (COVID-19) infection. DATA SOURCES Databases of Embase, PubMed, Web of Science, Science Direct, and Google Scholar were searched for studies reporting KL-6 levels in COVID-19 patients, published between January 2020 and September 30 2022. DATA SYNTHESIS For comparison between the groups, standard mean difference (SMD) and 95% confidence intervals (CI) were computed as the effect sizes. Sensitivity, specificity, positive likelihood ratio (PLR), and negative likelihood ratio (NLR) were measured to assess the diagnostic power of KL-6. In addition, the summary receiver operating characteristics curve (sROC) was constructed to summarize the true positive (TP), and false positive (FP) rates. To validate the findings of meta-analysis, Trial Sequential Analysis (TSA) was conducted. RESULTS Altogether 497 severe COVID-19 patients and 934 non-severe (mild to moderate) COVID-19 patients were included. Pooling of 12 studies indicated that the serum KL-6 level had significant association with severity of COVID-19 infection: standard mean difference = 1.18 (95% CI: 0.93-1.43), p = 0.01; I2: 58.56%]. Pooled diagnostic parameters calculated from eight studies were: sensitivity 0.53 (95% CI: 0.47-0.59); specificity 0.90 (95% CI: 0.88-0.93); positive likelihood ratio 4.80 (95% CI: 3.53-6.53); negative likelihood ratio 0.46 (95% CI: 0.32-0.68); and area under curve: 0.8841. Additionally, TSA verified the adequacy of sample size and robustness of the meta-analysis. CONCLUSION Serum KL-6 level has a moderate degree of correlation with the severity of COVID-19 infection but has low sensitivity. So, it is not recommended as a screening test for severe COVID-19 infection.

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“…A re-hospitalização dos pacientes após a alta foi observada na minoria dos casos, assemelhando-se ao estudo de Donnelly et al (2021), em que apresenta uma taxa de 19,9% de readmissões hospitalares após a alta por COVID-19. Dentre os fatores destacados que elevam risco para readmissões bem como a mortalidade, está a idade avançada (>60 anos), que pode estar relacionado a características imunológicas deficitárias nesta faixa etária (Perazzo et al, 2022).…”

Section: Discussionunclassified

Características sociodemográficas, sintomas persistentes e qualidade de vida de pacientes após hospitalização pela COVID-19

Nicolau

¹

,

Lotici²,

Perondi³

et al. 2023

RSD

0

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A COVID-19 é uma doença causada pelo vírus SARS-CoV-2 com manifestações leves a graves, como também levar à morte. Estudos têm demonstrado que pacientes que foram hospitalizados pela doença apresentam sintomas persistentes mesmo após longo período da alta, com impacto na qualidade de vida. Objetivo: Avaliar as características sociodemográficas, sintomas persistentes e a qualidade de vida de pacientes após hospitalização pela COVID-19 de um município do sudoeste do Paraná. Metodologia: Trata-se de um estudo descritivo-exploratório, de campo, transversal, com abordagem quantitativa, realizado com pacientes que foram hospitalizados devido a COVID-19, após a alta hospitalar em um município do sudoeste do Paraná. Realizou-se um cálculo amostral, assim a pesquisa constituiu-se por cinquenta (50) pacientes. Foram utilizados um questionário semiestruturado para avaliar as variáveis demográficas e dados clínicos do internamento além do instrumento WHOQOL-BREF; a escala de dispneia do Medical Research Council e a Escala Visual Analógica de dor. Resultados: Observou-se que 66% dos pacientes avaliados são do sexo masculino, sendo a maioria jovens, com ensino fundamental completo, casados, portadores de doenças crônicas, destacando-se a hipertensão arterial e a obesidade. Verificou-se que grande parte apresenta sintomas persistentes, predominando memória prejudicada e artralgia, mesmo após longo tempo de alta hospitalar, gerando impacto negativo na qualidade de vida. Conclusão: Pacientes que foram hospitalizados por COVID-19, especialmente homens, jovens, com comorbidades apresentam sintomas persistentes, após longo período de alta hospitalar, com impacto negativo na qualidade de vida, realçando assim a necessidade de acompanhamento a longo prazo a tais pacientes.

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In-hospital mortality and severe outcomes after hospital discharge due to COVID-19: A prospective multicenter study from Brazil

Cited by 25 publications

References 21 publications

Inflammasome Genetic Variants Are Associated with Protection to Clinical Severity of COVID-19 among Patients from Rio de Janeiro, Brazil

Inflammasome Genetic Variants Are Associated with Protection to Clinical Severity of COVID-19 among Patients from Rio de Janeiro, Brazil

Serum Krebs von den Lungen-6 for Predicting the Severity of COVID-19: A Systematic Review, Meta-Analysis, and Trial Sequence Analysis

Características sociodemográficas, sintomas persistentes e qualidade de vida de pacientes após hospitalização pela COVID-19

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